Editor's Note: CIDRAP's Promising Practices: Pandemic Influenza Preparedness Tools (www.pandemicpractices.org) online database showcases peer-reviewed practices, including useful tools to help others with their planning. This article is one of a series exploring the development of these practices. We hope that describing the process and context of these practices enhances pandemic planning.

Sep 2, 2008 (CIDRAP News)  In 2004 when the nation faced an influenza vaccine shortage, public health officials in Berkeley, Calif., saw an opportunity to put a different kind of dent in the flu season: they taught some of the city's youngest children how to WHACK the flu.

Tanya Bustamante, a pandemic influenza program specialist with the city of Berkeley's public health division, told CIDRAP News that officials developed a skit to teach kids in kindergarten through third grade how to avoid getting sick with the flu. "We needed a way to ramp up our community mitigation efforts," she said.

Because children are efficient "disease spreaders," an intervention focused on their actions is designed to reduce the flu burden in schools and in the general community, the city said in a press release in October 2007.

The city's public health planners built a flu prevention outreach activity around the word "whack" for its high-energy, cartoonish appeal for kids and because it offers a mnemonic device that teaches students good hand hygiene habits:

W, wash your hands often

H, home is where you stay when you're sick

A, avoid touching your eyes, nose, and mouth

C, cover your coughs and sneezes, and

K, keep your distance from people who are coughing or sneezing

Putting prevention in kids' handsThe activity consists of a 15-minute classroom skit performed by three University of California, Berkeley students. The student-actors explain the steps to the children with an engaging dialogue and a catchy, age-appropriate song, according to background materials on the program that are available on CIDRAP's Promising Practices Web database.

The characters in the skit, which the students portray with hand puppets, are Jane, a girl who is coughing and sneezing, her friend Mary, and Fred the Flu Germ, who keeps pestering Jane. The girls show the children how to avoid Fred and his friends by covering their coughs and sneezing into their elbows.

During the song part of the skit, the actors pretend to wash their hands, while inviting the children to follow along with the same hand motions while sitting at their desks.

At the end of the skit, the university students give the kids stickers, activity sheets, and posters for their classrooms. They ask teachers to fill out evaluation forms.

Creatively stretching public health dollarsBustamante said her department usually draws its volunteers from the UC Berkeley School of Public Health but have sought participants from the university's undergraduate departments, such as theater arts, biology, and education. "They [the students] enjoy the opportunity to get to know their own communities," she said.

The programheld in October before flu season startsis flexible and varies from classroom to classroom, she said. "The volunteers are helpful with coming up with ideas on how to involve kids in the skit. Sometimes the kids hold up cards with letters to review, and sometimes they practice covering their cough," she said. "The teachers get a little break and learn something that they themselves can build on in the classroom."

During the first year, the WHACK the Flu program made it to only a handful of schools, but since then they typically make it to eight of the city's 11 elementary schools, Bustamante said. "Our goal is to get into all the schools, but that can be difficult because of scheduling conflicts," she said, adding that the university students often have busy school schedules themselves.

Recent decreases in pubic health funding have forced Berkeley's public health department to scale back the program a little, offering it up through the second-grade level rather than through third grade, she said.

Still, Bustamante said the program costs are reasonable and allow the city to maximize and modify what they've found is a fun and powerful public health tool. "We've also taken this to the preschool Head Start program, parent groups, and childcare providers," she said. "We don't have a huge budget, but we make do."

Other communities are starting to adapt the WHACK the Flu theme, especially in California. Napa County said it would launch a similar program this fall. When Alameda County officials adopted the program, they introduced it at a community health carnival that featured games and activities centered around the theme.